MR-guided focused ultrasound has been approved to treat prostate cancer, bone metastases and uterine myoma... could liver cancer be on the horizon? German scientists at Fraunhofer Institute for Medical Image Computing MEVIS have developed a way to treat moving organs with the technology, which could usher in new targets.

The team of scientists are working as part of the Clinical Translation of Patient-Specific Planning and Conducting of FUS Treatment in Moving Organs (TRANS-FUSIMO) EU project that began in 2014 and runs until the end of 2018. The focus is on liver cancer right now, but they believe it would be possible to treat other moving organs such as the kidney, pancreas and lungs.

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“Patients with abdominal tumors must undergo multiple invasive interventions,” Dr. Mario Bezzi of the University La Sapienza in Rome, said in a statement. “MR-guided focused ultrasound can offer a genuine alternative to such interventions.”

Currently, MR-guided focused ultrasound can only be partially applied when treating moving organs. During the procedure, physicians have to control the patients’ breath by either having them hold their breath or putting them under anesthesia.

The patient lies in the MR and an image is generated every tenth of a second to show the current position of the liver. But that rate is not fast enough to reliably direct the ultrasound beam.

The Fraunhofer scientists have developed software that can calculate the next position of the treated region. It uses those calculations to find a path for the focused ultrasound waves to reach the tumor while the patient breathes freely.

The software was challenging to develop because it had to be highly reliable and run in real time without damaging the ribs. Since the ribs are in front of the liver, the scientists had to deactivate elements in the ultrasound transducer that would have hit that region.

For a preliminary test, a robotic arm moved a gel model back and forth in the MR scanner to simulate the movement of the liver. The model was simultaneously exposed to focused ultrasound and the MR monitored the temperature distribution.

The results matched the scientists’ expectations and their next step is to test it on patients. They plan to do that in mid-2018, and if the method proves itself they will collaborate with an industry partner to work toward medical product certification.